Patient Experience in Obstetrics in a Military Patient Satisfaction Survey: Findings and Recommendations for Improvement

ABSTRACT Introduction This study examines the care experience of obstetric patients within the Military Health System and compares them to those of medical and surgical care patients. Specifically, the study seeks to (1) examine how obstetric inpatient experience ratings differ from medical and surgical inpatient experience ratings, (2) understand specific aspects of care that drive overall experience ratings within this population, (3) test whether adherence to nursing practices such as hourly rounding and nurse leader visits affect experience ratings, and (4) describe ways that patient experience information can be presented to healthcare providers to improve performance. Materials and Methods Data for this study include Military Health System patient experience survey data (based on the Hospital Consumer Assessment of Healthcare Providers and Systems) collected from 2011 through 2019. Analysis includes data collected from 338,124 patients aged 18 years and older. Our analysis involved z-test comparisons of patient experience measure scores, trend analysis, logistic regression-based driver analysis, and correlations. Results Obstetric ratings are generally lower than those of medical and surgical patients; however, they have been improving at a slightly faster rate year over year. Effective nurse communications with patients are a particularly strong driver for improving their overall care experiences, and practices like hourly nurse rounding, nurse leader visits, and nurse–patient shift change conversations are positively correlated with obstetric patient experience ratings. Conclusions This study contextualizes how obstetric inpatient experience ratings differ from those of medical and surgical care patients. Healthcare administrators and policymakers should be aware that obstetric patients may have unique needs and expectations that lead to patient experience ratings differing from those of medical and surgical patients. Effective nurse–patient communications, hourly rounding, nurse leader visits, and nurse–patient shift change conversations could be strategies used to improve obstetric experience ratings.

Hourly Rounding and Fall Prevention among the elderly in long term care: A change process.

Long term care facilities have a rising rate of falls and fall related injuries with increasing cost and more hospitalization. Hourly rounding® is an evidenced based intervention that is proactive for nursing staff to be able to identify patient’s needs. This helps with positive fall prevention outcome. This project focused on process improvement efforts for 10 weeks and examining the education and implementation of an evidenced-based hourly rounding program that assisted in reducing the number of falls in the pilot unit. The implementation of the intervention took place in a long-term care facility located in Dallas, Georgia. The hourly rounding tools used in this project were the Studer Group hourly rounding log and competency checklist with permission. Twenty staff members were included in the sample, age 18 years and 60 years. The unit has 41 residents who were included in the pilot case study design. Staff members were first educated regarding hourly rounding and documentation on the hourly rounding log was done two days before implementation and the pre and post fall rate was retrieved from the facilities fall database. Competency checklist was completed prior to implementation and post implementation to evaluate staff understanding of the main tenets of the 4 P’s (potty, pain, possession, and position). For this project, descriptive statistics was used to help determine fall rates. Minitab was used to analyzed data and to determine if it was clinically significant. In the ten weeks following the hourly rounding implementation, participants performed hourly rounding by incorporating it to each resident’s daily routine and documented their rounds on the log sheet. The results indicated that it is statistically significant and with a P-values = -<0.0001 and t-value = -5.81.Keywords: Rounding and education; fall risk; fall reduction; older adult patients; quality improvement; fall prevention; fall and fall related injury.